Homestead_Hall s"'1A� CLAIM FOR HOMESTEAD PROPERTY TAX )
FORM YEAR
`. / STANDARD I SUPPLEMENTAL DEDUCTION HC10 Qif
�; rt
,.,, �. State Form 5473(R19 I 1-23)
` Prescnbed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions
NOTE Telephone.Social Security.driver's license.state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) I Mbe d) l r' \ certify that I(we)occupied as my(our)principal place of
residence or am(are)buying th following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date t application is s'gned. (date of signature) I(We)
n El AM are buying under recorded contract
0 Am(are;entitled to occupy as a tenant-stodeholder of a cooperative housing corporation
0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
0 Am(are)the shareholder,partner,or member of the entity that owns the property
CONTRACT RECORDED
If Buying on Contract.Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township "axing District(city town.(carship)
�jtbSDr► 0 • fir ic .-c-ar‘Ch
Parcel NumbberJ /y� Legal Descnption / is the property in question
'.I v-"'Ia WO,- Oa- y qO - 6 eal Property ❑Annually Assessed Mobile Hare(IC 6-1 1-7)
If any portion of the residential structure or the land not exceeding one(1;acre:•r0•.m.'r ea.alely surrounds that structure is used to produce income describe the use and portion
of the property utlized to produce income
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County,and Township Is Claimant Vacating a esteadr
I ❑yes ///No
I hereby certify the above statements are true.correct.and complete FOE / /
_ z��� Ale?/'�6 1/4/1/7
I Address of Contact(number and street.city state and ZiP code) _caress;i.3,3'en-': es!ead if any(rum er and street city. fate and ZiP code,
1 Ds E Mv ll be St re-rye L.I$
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE l! NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (21 l
A.:.9ELE9
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I ,
Manufactured Home Garage (5)
Other Improvements (6) FEB 0 9 2024
Total Improvements(Line 4 through Line 6) j(7)
j Total Value(Line 3 plus Line 7) I(8) A_ __/a )
Signature of Assessor GIB&61N brIEMI Y"AUUO TOR
I hereby certify the above is true,correct,and complete.
Verifying Action-Signature of Auditor 'Date Signed(date month.year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or 648 000
Notwithstanding any other provision.the sum of the deductions provided in IC 6-1 1-12 to a mobile home that S
Is not assessed as real property or to a manufactured home that s not assessed as real property may not
exceed one-half(1/2)of the assessed value of the mobile home or manufactured home
Signature of Auditor /3 t t�yt� Date Signed
�(^m/oynth.day year)
DISTRIBUTION' Original-County Auditor File-Stamped Copy-Taxpaye,
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